Imagine a person who has bipolar disorder, and also has diabetes and high blood pressure.
Maybe they self-medicate with alcohol or illegal drugs. Maybe they can’t keep a job and become homeless.

Living on the streets, they might develop more health problems, but not seek treatment until the issues become extreme. They might be more likely to go to emergency rooms, where treatment is more costly, or have to be admitted for inpatient services for problems that could have been fixed at home if caught earlier.

There are many such individuals in Oneida County, just as there are across the state and the nation, and their healthcare can be disproportionately expensive.

Now, the state, using funds obtained through federal Affordable Health Care Act, is in the process of setting up a system of entities called Health Homes to cope with this unique population. Health Homes will provide case managers to help better organize the healthcare of those in need.

Locally, Upstate Cerebral Palsy is the base for a Health Home that will serve a seven-county region, including Oneida, Herkimer, Lewis, Madison, Cayuga, Jefferson and St. Lawrence counties.

“I think by really looking out for the health of these people, they will have someone who is focusing on helping them get better,” said Laura Eannace, executive director of the local Health Home. “I think it will also help the entire system better manage this population.”

The first wave of Health Homes, most of them downstate, opened for business in January 2012, and already is showing results, the state’s Medicaid Director Jason Helgerson said.

“What we are beginning to see is the change in the ways we would expect,” he said. “Utilization reductions of 20 percent for inpatient services and in emergency rooms it’s even steeper, maybe cut in half.”

About 100 people were identified in the early starting regions. The cost of their care in the year before they joined the program totaled $47 million, or about $500,000 per person, he said. It’s too soon to know how much has been saved under the new system.

Nationwide, as much as 55 percent of Medicaid costs may be attributable to just 5 percent of the population, Lorie Martin of the Center for Healthcare Strategies, a non-profit healthcare resource, said.

“It’s better for them and it’s a better use of public dollars,” Martin said of the Health Homes program. “A few states are ahead of the curve, and New York is one.”

Oneida County’s share of the Medicaid costs generated by its residents for 2013 is projected to reach $56.4 million.

Eannace already has a preliminary list of people in the region who appear to need the Health Homes. In Oneida County alone, there are 691, and in Herkimer County the number is 173. Those numbers might go up as more information is gathered, she said.

The lists don’t say what medical costs these individuals have incurred in the past, but the numbers may be high.

Steve Darman of Social Science Associates, who researches issues of poverty and homelessness in the area, called the initiative “really big.”

“It’s really going to have a big and potentially positive impact on the high cost people,” he said.